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189 Cards in this Set
- Front
- Back
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What do steroids do? |
Help prevent sequelae of inflammation **used in acute conditions YOU ALWAYS WANT TO TREAT THE UNDERLYING CONDITIONS 1st |
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When are steroids used? |
Used only in acute situations of inflammation |
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What do steroids do? |
They affect every aspect of the immune system. *inhibit neutrophil migration * inhibit macrophage access to site of inflammation * BLOCK HISTAMINE SYNTHESIS |
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Steroid affects cont. |
*influence tissue repair -decrease capillary proliferation - decrease collagen deposition |
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True or false, Steroids can stabilize mast cells? |
True, remember steroids affect the entire immune system |
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Indications of steroids in the eye |
**they are contraindicated in the eye** -enhancement of the organism due to the reduction of the immune system **some exceptions to this -remember we can use this in severe infections that are starting to resolve |
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True or false, you can NEVER use steroids whenever there’s an active infection? |
False, you can use steroids on severe infections once they have started to resolve |
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HSK |
Remember you can use steroids on HSK if the virus has gotten into the stroma or lower (Must be tapered slowly) |
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Can you use steroids in HZV? |
Yes!! |
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Bacterial eye disease |
Staph can produce a secondary inflammation **you can use steroids while addressing underlying problems** |
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Culture proven bacterial eye infections |
Topical antibiotic for the first 48 hours BEFORE steroid **even with tx, there’s no BCVA difference at 3 months Same scar size Same time to epithelialize |
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Which of the following is False? When using steroids on an active bacterial infection A. There’s no difference is scar size B. There’s no difference in BCVA C. No change in time to reepithelialize s |
S |
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What are the actual benefits when using steroids on an active bacterial eye infection? |
Improvement with people with CF Va or worse People with central ulcers |
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Would you ever use steroids on Acanthamoeba or fungal keratitis? |
NO!!!! |
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True or false, NEVER USE STEROIDS ON ACANTHAMOEBA OR FUNGAL KERATITIS |
TRUE |
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Could you use steroids on pt with allergic conjunctivitis? |
Yes you can but its used for STABILIZATION not for maintenance |
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Why is steroids used in pt with allergic conjunctivitis? |
Remember steroids STABILIZE mast cells |
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True or false, steroids are used to tx allergic conjunctivitis by maintaining the conjunctiva |
False, they are used to stabilize the mast cells to prevent more bursts |
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Uveitis use with steroids |
Corticosteroids can reduce inflammation, relieve pain and help prevent posterior synechia |
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Non granulotamous vs granulotamous |
** NON Gram will have MORE symptoms (pain) than Granulomatous |
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Which is better for scleritis, NSAIDS or Steroids? |
NSAIDS |
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Would you use steroids on episcleritis |
YES |
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Post op inflammation |
Steroid use after post operative procedures can help prevent cystoid macular degeneration |
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What can steroids prevent in post operative pts? |
Can reduce inflammation which can greatly reduce the chance to develop cystoid macular degeneration |
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What can steroids do in post op refractive surgeries? |
They can reduce the chance for myopic regression They can reduce the chance for corneal haze in PRK patients |
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Steroid use in DED |
Steroids can be shown to jump start the effectivity of Celia, Restasis and Xiidra |
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What are SE or steroid use? |
- cataracts (PSC) -ocular hypertension/glaucoma - infection - delayed corneal epithelial healing |
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Which one of these is NOT a SE of steroid use in the eye? A. Ocular hypertension B. PSC C. Infection D. Delayed corneal healing |
ALL of these are SE of steroid use in the eye Remember steroids greatly affect the bodies natural ability to would heal infection and wound heal |
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True or false, you can reverse PSC whenever you D/C steroid use? |
False, D/C steroids will only Halt the progression but will NOT reverse. |
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Which is more common to cause PSC, Systemic steroids or Ocular steroids? |
Systemic!! |
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Which is more common to cause Ocular hypertension/ steroid induced glaucoma, Systemic or ocular steroids?s |
Ocular surface steroids!!! |
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Systemic/is steroids = PSC Ocular surface steroids= steroid induced glaucoma or ocular hypertension |
X |
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Ocular hypertension/ steroid induced glaucoma |
Very common with topical steroids Also common with nasal administered steroids **CAN BE CAUSED BY ALL TYPES OF STEROIDS** |
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True or false, ocular hypertension and steroids induced glaucoma can be caused by many types of steroids like nasal or topical steroids but not all steroids. |
False, ALL steroids can cause ocular hypertension or steroid induced Glaucoma |
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When does Ocular hypertension and steroid induced glaucoma occur when using steroids? |
Occurs generally in 2-8 weeks of initial therapy THESE CAN BE REVERSED IF DRUG IS D/C **remember PSC cannot be reversed if pt D/C steroids ** |
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“Steroid response” |
Seen in Glaucoma patients and their relatives |
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Groups of Ocular hypertension |
* average 1.6mmHg increase * average 10mmHg increase * average 16mmHg or more increase ***more than likely genetically determined |
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Which steroids are more likely to cause an increase in IOP? |
Dexamethasone, Difluprednate and prednisolone |
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Steroids that are less likely to cause an increase in IOP? |
Loteprednol, rimexolone and fluoroemthalone (LRF) |
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DDP or LFR |
Which is more likely to cause increase in IOP? ** DDP Which is less likely to cause increase in IOP? ***LRF |
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What does DDP stand for? |
Dexamethasone Difluprednate Prednisolone **these are more likely to cause and increase in IOP |
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What does LRF stand for? |
Lotoprednate Rimexolone Fluorometholone |
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what do you do before you prescribe Steroids? |
Check family Hx of hypertension/glaucoma related to steroids *ALWAYS check IOP first before you prescribe steroids * Always remeasure IOP on the follow up visit * NEVER ALLOW REFILLS ON STEROIDS |
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Which one of these statements are false regarding steroid use? A. Always measure IOP before you prescribe steroids B. You only need to measure IOP on follow up if they show sx C. Never allow for refills on steroids D. All of the above |
B. YOU ALWAYS. Recheck IOP whenever pt returns for their FU |
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What to do for patients that need Steroids but have a high IOP? |
You will most likely need to prescribe them a IOP lowering drop |
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Infection and steroid use |
Steroids can increase chance of infection and can mask symptoms **prolongs course of HSV and can reactivate HSV **enhances ocular susceptibility for FUNGAL INFECTION |
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Steroid and infection |
*steroids increase chance for infection and mask Sx * increase chance of fungal infections * can prolong/reactivate HSV |
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Steroids and infection |
Steroids can reduce corneal scarring **but if scarring is not a major concern, don’t prescribe the steroid** Weight the risks and benefits |
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Would you prescribe steroids to people if Corneal scarring is not a major concern? |
No, just weight the risk to benefits, Remember people are much more likely to get infections if they are using steroids |
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Principles or corticosteroid Therapy |
* The type and location of inflammation determines the route of administration of steroids *Dosage must be appropriate and must be reviewed and mod during therapy * long term/ high does steroid use should be tapered and not just discontinued to AVOID rebound inflammation |
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What are the principles of steroid therapy |
Type and route of inflammation determine ROA Always modify during treatment High doses and long term therapy need to tapered due to the possibility of rebound inflammation
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Specifics of topical steroids |
S |
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Types of steroids |
Acetate and Alcohols are lipophilic and can penetrate an intact cornea, Phosphate steroids cant penetrate an intact cornea but can penetrate a broken cornea easily *** for intact corneas use Alcohol and Acetates and for broken corneas use phosphates** |
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Dexamethasone antibiotic combos |
Maxitrol-(polymyxin B, neomycin) -comes in ointment and suspension, as well as brand and generic Tobradex- ointment (brand) and Suspension (brand/generic) |
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Is Tobradex and Maxitrol good for long term use? |
No, remember you don’t want to use these for long term use because you need to start tapering the steroid. So these are generally used for more acute situations!!! |
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Difluprednate |
-Newest Opthalmic steroid **very potent -ketone steroid formulated in Emulsion (NO SHAKING NEEDED) -This has a higher chance to increase the IOP than Prednisolone acetate |
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ALLERGIES |
ALLERGIES |
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VKC |
very severe ocular allergies, will have cobblestone papillae Occurs primarily during the spring time |
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AKC |
Atopic Keratoconjunctivitis Occurs all year round **will have other systemic allergies compared to VKC Will not have Cobblestone Papillae |
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Allergic response |
A few different types -Mass cells will burst and release chemical mediators (Histamine) |
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Type 1 hypersensitivity reaction |
Allergen binds to B lymphocytes IgE binds to mast cells and basophils Process= antigen binds to cells, IgE binds. To mast cells and basophils. Now cell membrane is more perm to Ca, thus Ca comes in and activates Phospholipase A2 and causes the mast cell to burst releasing all the cellular mediators |
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What happens when the mediators spill out? |
Itching Tearing Mucous production Conjunctiva vasodilation |
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Type 1 reaction |
SAC and PAC SAC=Pollen PAC=cat allergies ***Histamine release*** Lasts about 2days generally |
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Acetates/alcohols vs Phosphates |
Acetates and alcohols are MORE efficacious than phosphates The base of the steroid also influences formulation in many cases solution versus suspension. |
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SAC type 1 reaction |
**most common type of Ocular allergic reaction** Often asso with runny nose Most common mediator is histamine so the best treatment is ANTIHISTAMINES |
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SIGNS of SAC |
Swollen lids, ptosis Conj hypermedia/chemosis |
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Type 1 PAC |
Similar presentation to SAC but is generally caused by Molds, pet dander Year round symptoms *NO Pertinent damage like SAC |
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True or false, SAC and PAC generally have NO pertinent damage |
True! |
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Type 1 and Type 4 VKC |
Have histamine AND eosinophils Generally occurs in patients 3y/o to 25y/o Very common in the teenage years Lasts 4-10 years and resolves ***there can be tissue damage particularly on the Cornea but not as much as AKC*** |
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Which one of these statements is false regarding Type1/4 VKC? A. Cause more tissue damage compared to SAC and PAC but not as much corneal damage compared to AKC B. Occurs generally in the teenage years and last from 4-10 years and resolves C. Generally just has histamine release. D. All of the above are true |
C. Remember VKC has histamines and Eosinophil release |
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Types of VKC |
Limbal Tarsal Mixed |
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VKC cont |
Bilateral Most cases are seasonal Less seasonal exacerbations in the tropics closer to the equator |
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Sx of VKC |
Itching Tearing Mucous production BURNING Blepharospasms Blurred vision (mucous) |
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AKC type 1 and 4 |
*MOST SEVERE Type of Ocular allergic reaction* Developes inn 25% of patients that have contact dermatitis Often have other systemic allergies (Food, Hay fever, Hives) ***begins in late teens/early 20s*** |
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Prednisolone |
*analog of hyfrocortisone *availabe in acetate and phosphate suspension* |
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Sx of AKC |
Itching Tearing Watery discharge Burning Photophobia Blurred vision |
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Signs of AKC |
Tylosis (eyelid thickening) Eyelid edema Derm signs Upper lid ptosis **Dennie Morgan Folds** |
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Management of ocular allergies |
Stepped approach **always think about NON PHARMACOLOGICAL approach** |
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Non Pharm recommendations |
Keep hands away from eyes shampoo hair before bed Keep windows closed during peak allergy seasons |
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Stepped approach |
Topical therapy Oral Therapy |
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Topical therapy Decongestants |
**VASOCONSTRICTORS** -adrenergic agonists (Stim Sympathetics) Can be with or without antihistamines OTC available (cheap) **WILL HAVE REBOUND** |
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True or false, Decongestants cause a rebound hypermia and inflammation? |
true, This is a vicious cycle |
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Available decongestants |
**all OTC** Phenylephrine Naphazoline Oxymetazoline Tetrahydrozoline |
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Phenylephrine and the AZOLINEs are what type of topical allergic medications |
They are all decongestants |
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Name all of the decongestants (PNOT) |
Phenylephrine Naphazoline Oxymetazoline Tetrahydrozoline |
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Prednisolone Acetate 1% suspension |
*Pred Forte ***always get the brand*** |
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SE of decongestants |
Stinging Pupillary dilation Epi erosion(prolonged use) **REBOUND CONGESTION** |
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What are the CI of decongestants (PNOT) |
Heart issues Narrow Angles **remember these are adrenergic agonists so they will dilate the eye slightly so we don’t want to induce an angle closure** |
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Upneeq |
New drug used for mild blepharoptosis -FDA approved drug to relieve cosmetic ptosis (Oxymetazoline hydrochloride Ophth solution) ***30-60 units per carton .3ml per single dose unit 1 drop daily*** |
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Which one of these medications is FDA approved to treat cosmetic ptosis? A. Phenylephrine B. Naphazoline C. Oxymetazoline hydrochloride Oprah solution D. Tetrahydrozoline |
C. Oxymetazoline hydrochloride is the same thing as Upneeq Remember this is 0.3ml per use and you use it 1 time a day |
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Antihistamines |
These are the most common BEST ALLERGY Med for symptom relief and Safety These are good for acute reactions ****DO NOT USE Antihistamines on anaphylaxis**** |
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First generation Antihistamines |
Naphcon, Visine and Optcon Vasocon **all of these are paired with Naphazoline (decongestant) |
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True or false, generally 1st generation Antihistamines are paired with Oxymetazoline? |
false, they are generally paired with Naphazoline |
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Second generation Antihistamines |
***THESE ARE ALL DUAL ACTION*** Second gen= 2 action |
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Selective h1 blockers |
Can inhibit histamine release as well as other mediators from Mast cells |
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Mast cell Stabilizing antihistamines |
Olopatadine=(Pataday, Pazeo,Patanol) |
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Prednisolone Acetate 0.125% |
Suspension **Pred Mild (no generic) |
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Olopatadine |
(Pataday, patanol and pazeo) Pataday twice daily relief (olopatadine 0.1%)—15$ A bottle Pataday once daily relief (olopatadine 0.2%) Extra strength Pataday once daily Relief (Olopatadine 0.7%) ***extra strength is NOT a combo drug, just a dual mechanism** |
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Name all the Pataday |
Pataday twice daily (Olopatadine 0.1%) Pataday once daily (Olopatadine 0.2%) Pataday once a day extra strength (Olopatadine 0.7%) |
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Mast cell Stabilizers Ketotife (zaditor 0.025%, Alaway Claritin, Zyrtec) |
**THESE ARE DEFINITE MASS CELL STABILIZERS** May decrease chemotaxis and action Eosinophils **RAPID ONSET BID Dosing OTC Also has additional impact on cells migration to the eye compared to olopatadine Same signs and sx relief |
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What are disadvantages of Zatidor and Alaway and Claritin and Zyrtec? |
They must be used 2 times a day *they are complete Mast cell stabilizers** Unlike Olopatadine, these all must be used 2x daily ***WE GOTTA KNOW KITOTIFEN*** |
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True or false, Zyrtec and Claritin eye drops actually have Claritin and Zyrtec in them? |
False, they don’t actually include them in these but still use the name |
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What is the Major class of Mast Cell stabilizers we must know? |
Kitotifen *BID dosing* |
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Rx related Mast cell stabilizers |
***do NOT provid any better relief than OTC*** *Azelastine (optical 0.05%) BID -fast onset, but TERRIBLE TASTE IN THE MOUTH * Epinastine HCL (Elestat) BID * Bepotastine (Bepreve) BID *Alcaftadine (Lastacaft) ——dosed QD not BID
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What prescription mast cell stabilizer is dosed 1 times a day? |
Lastacraft (Alcaftadine) Last=last all day |
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What prescription Mast Cell Stabiilizer leaves a bad taste in the mouth? |
Optivar (Azelastine) |
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Newest Topical Antihistamine |
Cetrizine (zerviate) Same medication as oral Zyrtec H1 antagonist BID Rx ONLY (30 single use vials) NOT generally covered by insurance because the OTC options |
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Prednisolone Phosphate 1% |
Solution generic only |
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Which one of these antihistamines are OTC Only? A. Pataday B. Zaditor C. Alaway D. Optivar |
D Optivar *remember Optivar is Rx only and is taken BID and also leaves a terrible taste in the mouth |
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True or false, Cetrizine is much better option than Pataday in terms of cost and functionality |
False, remember OTC drugs are just as good as Rx drugs in terms of antihistamines Cetrizine is also NOT covered by insurance because the OTC options are available |
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Which one of the Rx antihistamines is a Single day use? |
Lastacraft!! Remember it lasts all day |
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True or false, Cetrizine has Zyrtec in it? |
True It’s a new Rx antihistamine that has the same compound that oral Zyrtec has It’s also expensive and come with 30 single dose bottles |
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What are the CI antihistamines? |
Same as the Decongestants (Can dilate so watch for narrow angles as well as any heart conditions) |
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Mast Cell Stabilizers |
***DO NOT EFFECT THE HISTAMINE THATS ALREADY BEEN RELEASED*** Generally have a lag time of 1-3 weeks but new ones are faster **Frequent dosing GREAT CHOICE TO PREVENT PAC SAC and VKC |
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Prednisolone |
Suspension= Acetate (Pred Forte “1%”, Pred Mild “.125%” Solution= Phosphate 1% **only generic no brand** |
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Match the different prednisolone to their solutions and |
Pred Forte- Pred 1% -Suspension Pred Mild- Pred 0.125%-Suspension Pred Phosphate- Pred Phosphate 1%- solution |
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Dexamethasone |
Not metabolized well (stays around in the anterior chamber longer) *solid anti inflammatory (strong steroid) Available in alcohol 0.1% suspension (Maxidex) |
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Dexamethasone vs Prednisolone |
Dexamethasone is an Alcohol and Prednisolone is an Acetate (besides the Phosphate version) |
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Types of steroids |
Acetate and Alcohols are lipophilic and can penetrate an intact cornea, Phosphate steroids cant penetrate an intact cornea but can penetrate a broken cornea easily *** for intact corneas use Alcohol and Acetates and for broken corneas use phosphates** |
|
|
Dexamethasone antibiotic combos |
Maxitrol-(polymyxin B, neomycin) -comes in ointment and suspension, as well as brand and generic Tobradex- ointment (brand) and Suspension (brand/generic) |
|
|
Is Tobradex and Maxitrol good for long term use? |
No, remember you don’t want to use these for long term use because you need to start tapering the steroid. So these are generally used for more acute situations!!! |
|
|
Difluprednate |
-Newest Opthalmic steroid **very potent -ketone steroid formulated in Emulsion (NO SHAKING NEEDED) -This has a higher chance to increase the IOP than Prednisolone acetate |
|
|
ALLERGIES |
ALLERGIES |
|
|
VKC |
very severe ocular allergies, will have cobblestone papillae Occurs primarily during the spring time |
|
|
AKC |
Atopic Keratoconjunctivitis Occurs all year round **will have other systemic allergies compared to VKC Will not have Cobblestone Papillae |
|
|
Allergic response |
A few different types -Mass cells will burst and release chemical mediators (Histamine) |
|
|
Type 1 hypersensitivity reaction |
Allergen binds to B lymphocytes IgE binds to mast cells and basophils Process= antigen binds to cells, IgE binds. To mast cells and basophils. Now cell membrane is more perm to Ca, thus Ca comes in and activates Phospholipase A2 and causes the mast cell to burst releasing all the cellular mediators |
|
|
What happens when the mediators spill out? |
Itching Tearing Mucous production Conjunctiva vasodilation |
|
|
Type 1 reaction |
SAC and PAC SAC=Pollen PAC=cat allergies ***Histamine release*** Lasts about 2days generally |
|
|
Acetates/alcohols vs Phosphates |
Acetates and alcohols are MORE efficacious than phosphates The base of the steroid also influences formulation in many cases solution versus suspension. |
|
|
SAC type 1 reaction |
**most common type of Ocular allergic reaction** Often asso with runny nose Most common mediator is histamine so the best treatment is ANTIHISTAMINES |
|
|
SIGNS of SAC |
Swollen lids, ptosis Conj hypermedia/chemosis |
|
|
Type 1 PAC |
Similar presentation to SAC but is generally caused by Molds, pet dander Year round symptoms *NO Pertinent damage like SAC |
|
|
True or false, SAC and PAC generally have NO pertinent damage |
True! |
|
|
Type 1 and Type 4 VKC |
Have histamine AND eosinophils Generally occurs in patients 3y/o to 25y/o Very common in the teenage years Lasts 4-10 years and resolves ***there can be tissue damage particularly on the Cornea but not as much as AKC*** |
|
|
Which one of these statements is false regarding Type1/4 VKC? A. Cause more tissue damage compared to SAC and PAC but not as much corneal damage compared to AKC B. Occurs generally in the teenage years and last from 4-10 years and resolves C. Generally just has histamine release. D. All of the above are true |
C. Remember VKC has histamines and Eosinophil release |
|
|
Types of VKC |
Limbal Tarsal Mixed |
|
|
VKC cont |
Bilateral Most cases are seasonal Less seasonal exacerbations in the tropics closer to the equator |
|
|
Sx of VKC |
Itching Tearing Mucous production BURNING Blepharospasms Blurred vision (mucous) |
|
|
AKC type 1 and 4 |
*MOST SEVERE Type of Ocular allergic reaction* Developes inn 25% of patients that have contact dermatitis Often have other systemic allergies (Food, Hay fever, Hives) ***begins in late teens/early 20s*** |
|
|
Prednisolone |
*analog of hyfrocortisone *availabe in acetate and phosphate suspension* |
|
|
Sx of AKC |
Itching Tearing Watery discharge Burning Photophobia Blurred vision |
|
|
Signs of AKC |
Tylosis (eyelid thickening) Eyelid edema Derm signs Upper lid ptosis **Dennie Morgan Folds** |
|
|
Management of ocular allergies |
Stepped approach **always think about NON PHARMACOLOGICAL approach** |
|
|
Non Pharm recommendations |
Keep hands away from eyes shampoo hair before bed Keep windows closed during peak allergy seasons |
|
|
Stepped approach |
Topical therapy Oral Therapy |
|
|
Topical therapy Decongestants |
**VASOCONSTRICTORS** -adrenergic agonists (Stim Sympathetics) Can be with or without antihistamines OTC available (cheap) **WILL HAVE REBOUND** |
|
|
True or false, Decongestants cause a rebound hypermia and inflammation? |
true, This is a vicious cycle |
|
|
Available decongestants |
**all OTC** Phenylephrine Naphazoline Oxymetazoline Tetrahydrozoline |
|
|
Phenylephrine and the AZOLINEs are what type of topical allergic medications |
They are all decongestants |
|
|
Name all of the decongestants (PNOT) |
Phenylephrine Naphazoline Oxymetazoline Tetrahydrozoline |
|
|
Prednisolone Acetate 1% suspension |
*Pred Forte ***always get the brand*** |
|
|
SE of decongestants |
Stinging Pupillary dilation Epi erosion(prolonged use) **REBOUND CONGESTION** |
|
|
What are the CI of decongestants (PNOT) |
Heart issues Narrow Angles **remember these are adrenergic agonists so they will dilate the eye slightly so we don’t want to induce an angle closure** |
|
|
Upneeq |
New drug used for mild blepharoptosis -FDA approved drug to relieve cosmetic ptosis (Oxymetazoline hydrochloride Ophth solution) ***30-60 units per carton .3ml per single dose unit 1 drop daily*** |
|
|
Which one of these medications is FDA approved to treat cosmetic ptosis? A. Phenylephrine B. Naphazoline C. Oxymetazoline hydrochloride Oprah solution D. Tetrahydrozoline |
C. Oxymetazoline hydrochloride is the same thing as Upneeq Remember this is 0.3ml per use and you use it 1 time a day |
|
|
Antihistamines |
These are the most common BEST ALLERGY Med for symptom relief and Safety These are good for acute reactions ****DO NOT USE Antihistamines on anaphylaxis**** |
|
|
First generation Antihistamines |
Naphcon, Visine and Optcon Vasocon **all of these are paired with Naphazoline (decongestant) |
|
|
True or false, generally 1st generation Antihistamines are paired with Oxymetazoline? |
false, they are generally paired with Naphazoline |
|
|
Second generation Antihistamines |
***THESE ARE ALL DUAL ACTION*** Second gen= 2 action |
|
|
Selective h1 blockers |
Can inhibit histamine release as well as other mediators from Mast cells |
|
|
Mast cell Stabilizing antihistamines |
Olopatadine=(Pataday, Pazeo,Patanol) |
|
|
Prednisolone Acetate 0.125% |
Suspension **Pred Mild (no generic) |
|
|
Olopatadine |
(Pataday, patanol and pazeo) Pataday twice daily relief (olopatadine 0.1%)—15$ A bottle Pataday once daily relief (olopatadine 0.2%) Extra strength Pataday once daily Relief (Olopatadine 0.7%) ***extra strength is NOT a combo drug, just a dual mechanism** |
|
|
Name all the Pataday |
Pataday twice daily (Olopatadine 0.1%) Pataday once daily (Olopatadine 0.2%) Pataday once a day extra strength (Olopatadine 0.7%) |
|
|
Mast cell Stabilizers Ketotife (zaditor 0.025%, Alaway Claritin, Zyrtec) |
**THESE ARE DEFINITE MASS CELL STABILIZERS** May decrease chemotaxis and action Eosinophils **RAPID ONSET BID Dosing OTC Also has additional impact on cells migration to the eye compared to olopatadine Same signs and sx relief |
|
|
What are disadvantages of Zatidor and Alaway and Claritin and Zyrtec? |
They must be used 2 times a day *they are complete Mast cell stabilizers** Unlike Olopatadine, these all must be used 2x daily ***WE GOTTA KNOW KITOTIFEN*** |
|
|
True or false, Zyrtec and Claritin eye drops actually have Claritin and Zyrtec in them? |
False, they don’t actually include them in these but still use the name |
|
|
What is the Major class of Mast Cell stabilizers we must know? |
Kitotifen *BID dosing* |
|
|
Rx related Mast cell stabilizers |
***do NOT provid any better relief than OTC*** *Azelastine (optical 0.05%) BID -fast onset, but TERRIBLE TASTE IN THE MOUTH * Epinastine HCL (Elestat) BID * Bepotastine (Bepreve) BID *Alcaftadine (Lastacaft) ——dosed QD not BID
|
|
|
What prescription mast cell stabilizer is dosed 1 times a day? |
Lastacraft (Alcaftadine) Last=last all day |
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What prescription Mast Cell Stabiilizer leaves a bad taste in the mouth? |
Optivar (Azelastine) |
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Newest Topical Antihistamine |
Cetrizine (zerviate) Same medication as oral Zyrtec H1 antagonist BID Rx ONLY (30 single use vials) NOT generally covered by insurance because the OTC options |
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Prednisolone Phosphate 1% |
Solution generic only |
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Which one of these antihistamines are OTC Only? A. Pataday B. Zaditor C. Alaway D. Optivar |
D Optivar *remember Optivar is Rx only and is taken BID and also leaves a terrible taste in the mouth |
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True or false, Cetrizine is much better option than Pataday in terms of cost and functionality |
False, remember OTC drugs are just as good as Rx drugs in terms of antihistamines Cetrizine is also NOT covered by insurance because the OTC options are available |
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Which one of the Rx antihistamines is a Single day use? |
Lastacraft!! Remember it lasts all day |
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True or false, Cetrizine has Zyrtec in it? |
True It’s a new Rx antihistamine that has the same compound that oral Zyrtec has It’s also expensive and come with 30 single dose bottles |
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What are the CI antihistamines? |
Same as the Decongestants (Can dilate so watch for narrow angles as well as any heart conditions) |
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Mast Cell Stabilizers |
***DO NOT EFFECT THE HISTAMINE THATS ALREADY BEEN RELEASED*** Generally have a lag time of 1-3 weeks but new ones are faster **Frequent dosing GREAT CHOICE TO PREVENT PAC SAC and VKC |
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Prednisolone |
Suspension= Acetate (Pred Forte “1%”, Pred Mild “.125%” Solution= Phosphate 1% **only generic no brand** |
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Match the different prednisolone to their solutions and |
Pred Forte- Pred 1% -Suspension Pred Mild- Pred 0.125%-Suspension Pred Phosphate- Pred Phosphate 1%- solution |
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Dexamethasone |
Not metabolized well (stays around in the anterior chamber longer) *solid anti inflammatory (strong steroid) Available in alcohol 0.1% suspension (Maxidex) |
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Dexamethasone vs Prednisolone |
Dexamethasone is an Alcohol and Prednisolone is an Acetate (besides the Phosphate version) |
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what are the topical dual action antihistamines? |
BOLE Olopatadine Ketotifen |
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BOLE means what |
Bepreve Optivar (bad taste) Lastacaft (only QD dose) Elestat |
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what is the newest topical dual action antihistamine |
Zerviate this actually has Zyrtec |
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What is the ONLY corticosteroid FDA approved for allergic conjunctivitis? |
Loteprodnol Etabonate 0.2% |
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Loteprednol Etabonate (0.2%) ALREX |
only FDA approved corticosteroid |
